Leaving no one behind: Intellectual disability during COVID-19 in Africa

Introduction

Theoretical and empirical evidence has revealed that people living with disability are the most vulnerable yet ignored in most societies, especially in Africa. The systematic exclusion of persons with disabilities, 80 per cent of whom live in the Global South, is all the more devastating given that the text of the United Nations 2030 Agenda for Sustainable Development specifically references the need to include persons with disabilities 11 times. Notwithstanding, the disabled are among the marginalised groups as they bear the brunt of fragility and disparity. Often times people with intellectual disability (ID) are excluded from normal daily activities, and they are shunned from the society. This is social exclusion, arising from cultural perceptions, a lack of equal opportunities, and barriers to learning and participation. Thus far, there are important collaborations internationally, among which is the long-standing work SINTEF (Stiftelsen for industriell og teknisk forskning) in Norway, which has implemented a disability movement in various sub-Saharan countries. The reports on living conditions of disabled people in a number of African countries, all conducted together with SINTEF, are foundational to much of the research in the region. Despite such collaborations, the area of ID has not been explored a lot, especially in Africa, where ID is probably the largest impairment grouping on the African continent.

According to Gluck (2014), the term ID refers to a condition in which a person has certain limitations in intellectual functions such as communicating and taking care of himself or herself, and has impaired social skills. These limitations cause a child to intellectually develop more slowly than other children. These children may take longer to walk, talk and take care of themselves than the typical, unimpaired, child. It is probable that children with intellectual disabilities will have difficulty learning in school.

This brief provides a synopsis of the challenges affecting people with ID and those in the profession of social work during COVID-19, seen through as countries continue to do lockdowns. It further outlines the opportunity for African states to have a COVID-19 inclusive recovery plan.

How COVID-19 might affect people living with ID

The COVID-19/coronavirus pandemic has caught many nations off guard. However, many nations in attempts to curb the spread of the coronavirus applied strict measures such as lockdown. As a result of lockdown, many services and businesses have been suspended, and there is limited human movement as business has shifted to online platforms.

Arguably, when countries applied various forms of lockdown, the intention was to slow the spread of the virus and allow governments time to prepare their respective health sectors. Lockdowns have major impacts on people’s livelihoods through negative effects on employment and earnings. According to Marmot (2005), persons with disabilities are at higher risk of exposure to challenging living and working conditions associated with poorer health outcomes, such as lower income and greater employment insecurity.

According to Jahoda et al. (2008), employment provides an opportunity for financial autonomy and plays a key role in the well-being and quality of life of persons living with disabilities. Entrepreneurs with ID face the same hurdles as other entrepreneurs; however, their difficulties are multiplied, especially during a crisis like COVID-19 where people have to adhere to health protocols such as wearing masks, washing hands and sanitising, which are a challenge to them. However, public health strategies often do not consider people with disabilities, leaving a gap in guidance. Furthermore, even those who have the ability to use personal protective equipment (PPE), the equipment is limited as most governments, if not all, do not give PPE for free except for frontline workers in the health sector.

Unfortunately, such strict measures have resulted in many people living with developmental disabilities no longer having physical access to their normal routine of making a livelihood. The disabled who are not in care homes usually get regular visits from social workers; however, with restricted movements, many were left alone and some were abused because there was no monitoring from social workers.

As countries are on lockdowns with limited movements, people with ID are likely to suffer from psychological problems. According to Goldmann and Galea (2014), research on COVID-19 shows that the coronavirus pandemic has increased psychological distress both in the general population and among high-risk groups such as people living with ID. Measures like social distancing, as well as their social and economic impacts, are worsening mental health consequences. In addition, Goldmann and Galea (2014) stated that the psychological impact of mass trauma (e.g. natural disasters, flu outbreaks) suggests that the pandemic might particularly harm the mental health of marginalised populations who have less access to socioeconomic resources and supportive social networks. Some people with ID are in care homes, but because of health protocols during COVID-19, institutions have stopped visitations to centres. Such isolation is likely to cause depression. There is also a high possibility of fatigue among social workers because many people with disability (PWD) are likely to be sent to centres for special care. It is difficult for people with ID to maintain distancing as they are dependent on others to fulfil physiological requirements.

Meanwhile, as COVID-19 continues to spread like a veld fire in African nations, quarantine centres have been under criticism for lack of accessibility and user-friendly facilities where people are quarantined. This is because some quarantine facilities have been criticised for not having disabled-friendly features such as lifts and bathrooms with rails. This is an indication that the disabled, as among the vulnerable across the world, are often left, and that puts them at high risk.

Intellectual disabilities in children cause learning difficulties, social problems, and motor skill impairment and adversely affect their ability to perform successfully in daily life. This negatively impacts a child’s ability to learn in a typical educational setting (Gluck, 2014). As COVID-19 has pushed all sectors to operating online, most schools are now operating online. This pandemic has exposed persistent digital inequalities. According to Kairutha (2020), Africa has significant digital infrastructure and skills gaps with between 5 and 50 per cent of the population having consistent access to the Internet compared to 80 per cent and above in Europe and North America. The gap is replicated in other sectors of the economy due to the bottlenecks in digital infrastructure. Within education, for example, 39 per cent of university students in Africa report enrolling for online classes during the pandemic, with significant regional variations: 17 per cent in West Africa, 43 per cent in East Africa and 41 per cent in Southern Africa. These gaps imply that digital technology has a vast potential to improve the livelihood in Africa through job creation, but information technology (IT) is a double-edged sword as many will not be able to use it; many students with intellectual disabilities have not been exposed to this technology, as schools have not previously considered it relevant. Plus, online teaching may be tiring for children and students with disabilities, especially those who have attention deficit. Children with ID need highly skilled personnel; however, many African states are still lagging behind, social workers are not in a position to teach children, and there is shortage of teachers with specialised skills in Africa.

Lack of proper communication during this pandemic is a challenge for people with ID. While many countries are using various platforms to share the messages about COVID-19 on social media and televisions, the vulnerable are often left behind because communication is passed through these platforms and people are wearing masks. In addition, some countries are experiencing difficulties with sign language because national interpreters on the television usually communicate in a different sign language from what they are used to. This also tends to put pressure on some social workers who end up having to interpret the message to people under their care.

Challenges for social workers during COVID-19

The profession of social work is an interesting profession that cuts across all the sectors of the economy. Some research states that during COVID-19 the professionals are doing fairly well, but that does not mean there are no challenges. COVID-19 is quite a difficult time for social workers who find themselves being overworked. During COVID-19, there is no sector that does not need a social worker, especially as one of the roles is to provide pyschosocial support. Social workers are fatigued, there is too heavy a workload and they are limited. The normal lives of social workers have been disrupted because some have to move to care centres to visit people, thereby leaving their homes and later facing discrimination that they are bringing the virus to the communities. Some centres are in need of social services but they have financial challenges that affect the remuneration of social workers who go overboard to do their job at a time like this.

Concluding remarks

COVID-19 has come to expose loop holes in many governments. Clearly, the profession of social work is critical, and it cuts across all sectors. It took a world pandemic like COVID-19 for the importance of social work to be realised, yet it is given less attention by many governments in Africa. In addition, PWD are among the vulnerable groups across the globe and are at high risk of COVID-19, but their perspective is not being included in the efforts to address inequities in the response. This includes understanding the unique challenges that this community continues to face across all sectors of the economy, namely education, health, business and home.

The path towards successful participation and inclusivity of people living with ID during COVID-19 is not without hurdles. The barriers include lack of PPE, lack of user-friendly facilities, and lack of Internet access. To overcome these obstacles, Africa should set a conducive disability-friendly environment so that PWD can also exercise their rights like any other persons, especially during COVID-19.

Recommendations

Inclusion of persons with disabilities in the COVID-19 response and recovery is a vital part of achieving the pledge to leave no one behind, and a critical test of the global commitments of the Convention of the Rights of Persons with Disabilities (CRPD), the 2030 Agenda for Sustainable Development, the Agenda for Humanity and the United Nations Disability Inclusion Strategy.

Governments should ensure caregivers and people living with ID are prioritised and given PPE to reduce the risk of transmission between caregivers and the people with disabilities they are caring for.

Governments should consider having policies that ensure that, in the event of such a pandemic like COVID-19, persons with disability are given basic facilities in case their primary caregiver is quarantined.

It is imperative that countries should establish and strengthen public–private partnership so that both the public and private sectors could continue to provide sufficient funding to sustain residential services offered by social workers through this emergency, to include overtime hours of work, suspension of holidays and leave in order to cover staff absences and maintenance of service and social care provision in the absence of family and community visitors and volunteers, as well as purchase of equipment and aids to prevent contagion.

There is a need to call for collaboration with social care organisations to organise the online education platforms. Such collaboration will ensure that programmes are tailor made specifically for children with ID. There is also a need to capacitate teachers of PWD and the social workers as they spend more time with them.

It is imperative that governments encourage all those in the media fraternity, local and private, to cater for PWD by including captions and sign language for all live and recorded events and communications. In other words, communication mediums should be made accessible to people with ID. Furthermore, governments should consider having a curriculum with a standard sign language that can be understood by all.